| Abdomen 2 views (74019) |
$100.75 |
$201.50 |
1.0× |
| Ankle 2 views (73600) |
$142.50 |
$285 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$142.50 |
$285 |
1.7× |
| Chest 1 view (71045) |
$100.75 |
$201.50 |
1.2× |
| Clavicle complete (73000) |
$100.75 |
$201.50 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$99.50 |
$199 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,220 |
$2,440 |
3.6× |
| CT abdomen and pelvis without contrast (74176) |
$770 |
$1,540 |
3.4× |
| CT abdomen w contrast (74160) |
$782.50 |
$1,565 |
4.6× |
| CT abdomen w wo contrast (74170) |
$876 |
$1,752 |
5.2× |
| CT abdomen w/o contrast (74150) |
$390 |
$780 |
3.9× |
| CT c-spine w/o contrast (72125) |
$390 |
$780 |
3.9× |
| CT chest w/wo contrast (71270) |
$876 |
$1,752 |
5.2× |
| CT chest with contrast (71260) |
$782.50 |
$1,565 |
4.6× |
| CT head/brain without and with contrast (70470) |
$876 |
$1,752 |
5.2× |
| CT lower ext w/o (73700) |
$390 |
$780 |
3.9× |
| CT lower extremity w wo contrast (73702) |
$876 |
$1,752 |
5.2× |
| CT lower extremity with contrast (73701) |
$782.50 |
$1,565 |
4.6× |
| CT lumbar spine w & w/o contrast (72133) |
$876 |
$1,752 |
5.2× |
| CT lumbar spine w/o contrast (72131) |
$390 |
$780 |
3.9× |
| CT maxillofacial w/o contrast (70486) |
$390 |
$780 |
3.9× |
| CT neck soft tissue w contrast (70491) |
$782.50 |
$1,565 |
4.6× |
| CT orbits w/o contrast (70480) |
$390 |
$780 |
3.9× |
| CT pelvis w/o contrast (72192) |
$390 |
$780 |
3.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$876 |
$1,752 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
$390 |
$780 |
3.9× |
| CT thoracic spine w/o contrast (72128) |
$390 |
$780 |
3.9× |
| CT thorax w/o contrast (71250) |
$390 |
$780 |
3.9× |
| CT upper extremity w/o contrast rt (73200) |
$390 |
$780 |
3.9× |
| CT upper extremity with contrast (73201) |
$782.50 |
$1,565 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$916 |
$1,832 |
5.4× |
| Cta Abdomen (74175) |
$916 |
$1,832 |
5.4× |
| CTA abdomen pelvis (74174) |
$876 |
$1,752 |
2.6× |
| CTA chest (71275) |
$916 |
$1,832 |
5.4× |
| Cta Head (70496) |
$916 |
$1,832 |
5.4× |
| Cta Neck (70498) |
$916 |
$1,832 |
5.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$121.25 |
$242.50 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$219 |
$438 |
1.0× |
| Foot 2 views (73620) |
$112.50 |
$225 |
1.3× |
| Forearm 2 views (73090) |
$100.75 |
$201.50 |
1.2× |
| Hand 2 views (73120) |
$152.50 |
$305 |
1.5× |
| Hand 3 views (73130) |
$100.75 |
$201.50 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$619.75 |
$1,239.50 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$100.75 |
$201.50 |
1.2× |
| Knee 3 views (73562) |
$142.50 |
$285 |
1.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,569.50 |
$3,139 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$930.50 |
$1,861 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$930.50 |
$1,861 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$930.50 |
$1,861 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,569.50 |
$3,139 |
4.7× |
| MRI pelvis w/o contrast (72195) |
$930.50 |
$1,861 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,569.50 |
$3,139 |
4.7× |
| MRI thoracic spine w/o contrast (72146) |
$930.50 |
$1,861 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$930.50 |
$1,861 |
4.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,569.50 |
$3,139 |
4.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$930.50 |
$1,861 |
4.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,761.25 |
$3,522.50 |
1.4× |
| Neck soft tissue (70360) |
$100.75 |
$201.50 |
1.2× |
| Nm gastric emptying study (78264) |
$506.25 |
$1,012.50 |
1.3× |
| Nuclear medicine of heart pumping function (78473) |
$560 |
$1,120 |
1.5× |
| Parathyroid imaging (78070) |
$472.75 |
$945.50 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$147.50 |
$295 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$100.75 |
$201.50 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$168 |
$336 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$147.50 |
$295 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$100.75 |
$201.50 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$147.50 |
$295 |
1.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$100.75 |
$201.50 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$100.75 |
$201.50 |
1.2× |
| Ribs bilateral 3 views (71110) |
$147.50 |
$295 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$120.75 |
$241.50 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$32.50 |
$65 |
1.4× |
| Spine thoracic 3 views (72072) |
$152.50 |
$305 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$236 |
$472 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$198.25 |
$396.50 |
2.0× |
| Us breast unilateral limited (76642) |
$160.50 |
$321 |
1.9× |
| Us chest (76604) |
$126 |
$252 |
1.3× |
| Us pelvic non ob complete (76856) |
$236 |
$472 |
2.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$160.50 |
$321 |
1.6× |
| Us pregnancy ltd (76815) |
$236 |
$472 |
2.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$236 |
$472 |
2.3× |
| Us retroperitoneal limited (76775) |
$236 |
$472 |
2.3× |
| Us scrotum and contents (76870) |
$236 |
$472 |
2.3× |
| Us soft tissue head/neck (76536) |
$236 |
$472 |
2.3× |
| Us xtr non-vasc lmtd (76882) |
$160.50 |
$321 |
1.6× |
| Wrist 2 views (73100) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$147.50 |
$295 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$142.50 |
$285 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$112.50 |
$225 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$112.50 |
$225 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$142.50 |
$285 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$146.75 |
$293.50 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$147.50 |
$295 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$147.50 |
$295 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$142.50 |
$285 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$147.50 |
$295 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$142.50 |
$285 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$112.50 |
$225 |
1.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$147.50 |
$295 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$147.50 |
$295 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$100.75 |
$201.50 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$112.50 |
$225 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$152.50 |
$305 |
1.5× |
| Xr finger(s) 2+ views (73140) |
$100.75 |
$201.50 |
1.2× |
| Xr shoulder 1 view (73020) |
$100.75 |
$201.50 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$152.50 |
$305 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$100.75 |
$201.50 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$112.50 |
$225 |
1.3× |